Urethral cancers are rare malignancies of the urethrathe tube that carries urine from the bladder to outside of the body, the tube that carries urine from the bladdera hollow, muscular sac in the pelvis that stores urine to outside of the body. The presentation of urethral cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs varies between men and women, due to differences in their anatomy and physiology.
In men, the urethra is approximately 21cm long, and it runs from the end of the bladder to the urethral opening (opening to the outside of the body in the tip of the penis), carrying both urine and sperm. The most common type of urethral cancers in men are urothelial carcinomas (also known as transitional cell carcinomacancer arising from tissues that line organs – cancer arising from transitional cellsthe basic structural and functional unit of all living things that line organs), followed by squamous cell carcinomas (cancer arising from squamous cells that line organs) and adenocarcinomas (cancer arising from mucus-producing glands in organs).
In women, the urethra is approximately 3-4cm long, and it runs from the end of the bladder to the urethral opening. It sits below the clitoris and above the vaginal opening, and carries only urine. The most common type of urethral cancers in women is squamous cell carcinomas, followed by urothelial carcinomas, and adenocarcinomas.
Urethral cancers are more common in men, and is most commonly found over the age of 60. However, anyone can develop this disease.
Treatment
If urethral cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including sex, location, stage of disease and overall health.
Treatment options for men include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Transurethral resection (TUR)removal of abnormal tissue through a tool inserted into the urethra.
- Urethrectomycomplete or partial removal of the urethra.
- Penectomycomplete or partial removal of the penis.
- Lymphadenectomysurgical removal of lymph node(s).
- Cystourethrectomyremoval of the bladder and urethra.
- Cystoprostatectomyremoval of the bladder and prostate.
- Urinary diversioncreating a new pathway for urine to exit the body when urine flow is blocked.
- Urostomya surgical procedure that creates a new opening (stoma) in the abdomen to allow urine to drain from the body when the bladder is removed or not functioning properly.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Watch and waitthe close monitoring of a cancer without giving treatment until symptoms appear or worsen.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Treatment options for women include:
- Surgery, potentially including:
- Transurethral resectionsurgical removal of tissue or part/all of an organ (TUR).
- Urethrectomy.
- Lymphadenectomy.
- Cystourethrectomy.
- Vaginectomycomplete or partial removal of the vagina.
- Urinary diversion.
- Urostomy.
- Radiation therapy.
- Chemotherapy.
- Watch and wait.
- Clinical trials.
- Palliative care.
Urethral Cancer Treatment and Fertility
Some treatment for urethral cancer may make it difficult to conceive or carry a child. If fertility is important to you, discuss your options with your doctor and a fertility specialist prior to the commencement of treatment.
Risk factors
While the cause of urethral cancer remains unknown, the following factors may increase the riskthe possibility that something bad will happen of developing the disease:
- Having a personal or family history of bladder, ureter and/or renal pelvis cancers.
- Having conditions that cause chronica long-lasting disease that changes slowly over time inflammation in the urethra, including:
- Sexually transmitted diseases (STDs), including human papillomavirus (HPV).
- Frequent urinary tract infections (UTIs).
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Some of the information regarding risk factors was obtained from the Urethral Cancer—Patient Version page published by the National Cancer Institute.
Symptoms
Symptoms often present differently in men and women.
In men, symptoms of urethral cancer may include:
- Urethral strictures, which carries its own set of symptoms:
- Decreased urine stream.
- Feeling like you need to urinate after urinating.
- Difficulty, straining and/or pain while urinating.
- Polyuriafrequent urination.
- Frequent urinary tract infections (UTIs).
- Haematuriathe presence of blood in urine.
- Dysuriaburning, tingling and/or stinging of the urethra when urinating.
- Unusual discharge.
- Genital swelling.
- Priapismprolonged penile erection.
- Abscesses in the urethra.
- Fistulaan abnormal connection or passage between two organs, vessels, or cavities in the body that do not usually connect.
- Constipationa condition where a person has difficulty passing faeces/stools.
- A lump in the penis.
In women, symptoms of urethral cancer may include:
- Irritative voiding, which carries its own set of symptoms:
- Polyuria.
- Painful urination.
- Urinary incontinenceloss of control over release of urine or faeces.
- Haematuria.
- Pain during or after intercourse.
Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have urethral cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Pelvic examinationa physical exam of the external and internal female pelvic organs.
- Digital rectal examinationan examination conducted by a urologist where a finger (or digit) is inserted into the rectum to feel the anus (DRE).
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- Ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
- Blood teststesting done to measure the levels of certain substances in the blood.
- Urine teststesting done to measure the levels of certain substances in the urine.
- Ureteroscopyexamination of the bladder and ureters using a small, flexible instrument called a ureteroscope .
- Biopsyremoval of a section of tissue to analyse for cancer cells.
